In last two decades, incidence of Cesarean Section (delivery through an abdominal incision) has been constantly rising at a high rate. In UK and other western countries, the average rate of Cesarean Section is around 25% and continues to increase. A significant proportion of Cesarean Sections are performed during second stage or when women are in late stages of labour. Along with these statistics there are been a rising trend in failed instrumental deliveries, adding to this group of patients. There is evidence that Cesarean Section performed in these circumstances is prone to higher complications both for the baby and the mother.
The mechanism of difficult delivery of the fetal head during a Cesarean Section is not entirely clear. However, it is clear that such situations rarely, if ever, exist in elective Cesarean Section. It follows that the impaction of fetal head is a manifestation of an advanced first stage, and much more likely, an event of the second stage.
Moreover, the impaction seems to be more likely when the second stage is unduly prolonged. Clinician has to decide in these circumstances whether to try an instrumental vaginal delivery or carry out a Cesarean Section. Therefore, some of these cases can be due to a reluctance to perform an instrumental delivery. The greater use of Cesarean Section and the reduction in instrumental deliveries has compounded this problem.
There is also an increased use of epidural analgesia in labour often resulting in a prolonged second stage of labour due to lack of maternal urge to push. This could be another mechanism for the impaction of fetal head in the maternal pelvis.
The deeply engaged fetal head is likely to lead to difficulty in delivery during Cesarean Section often leading to a delay in uterine decision, delivery interval resulting in hypoxic trauma to fetus. Degree of this trauma depends on the amount of delay. There is also risk of direct injury to fetus due to force used during the attempted delivery by the operator.
The use of assistant to help in pushing the fetal head through the vaginal route has been also suggested. This technique can also cause direct trauma to the fetus and lead to delay in delivery. A higher rate of maternal trauma and infections has also been reported while using this technique.
Use of the vacuum instrument recommended in this situation, it also adds to delay in delivery of an already compromised fetus. Other techniques described are breech extraction, which is often difficult and traumatic unless the operator is familiar with it.
Extension of uterine incision is quite common when the Cesarean Section is carried out at late stage of labour, incidence of around 35% has been reported. This often leads to increased blood loss and need for blood transfusion and higher risk of trauma to urinary tract during attempts to repair this.
Medicolegal risks of second stage Cesarean Section are significant. The Royal College of Obstetricians and Gynecologists (U.K.) have suggested that there should be more experienced help at hand when such a situation arises (Sentinel Audit).
To address above mentioned problems in child birth it would be beneficial to have a device which can be used for assisting obstetrician in a delivery of fetus during a Cesarean Section. This device could be of substantial benefit to the patient and could also be used in the situation when a cord prolapse has occurred, thus allowing the fetal head to be pushed up thereby allowing more time to prepare for an emergency Cesarean Section.
Such an invention could also be useful when performing Cesarean Section in premature or small babies and could be novel in use for dislodging the fetal head which is deeply wedged in the pelvic cavity and to deliver fetus without undue delay and trauma that could be beneficial for baby.
Hence there is clear need for a device, which can dislodge or push the fetus head up in the uterus and facilitate the delivery in a non-traumatic or safe fashion.
The present invention is novel and relates to use of a device to assist surgeon in performing a Cesarean Section.